Vol 61 No 3 2021
Exhibits from Carl Rokitansky (1804-1878).
Pathology Museums for the 21st Century
By Dr. Robin A. Cooke
Throughout my term as Editor of the News Bulletin, I featured many pathology museums that I visited in my travels.
Medical Museums were an essential part of every medical school in the latter part of the 19th century, and the first half of the 20th century.
Their importance waned in the second half of the 20th century as more emphasis was placed on the teaching of other subjects, even to the point where some University educators removed pathology from the curriculum.
Towards the end of the 20th century there was a resurgence in the teaching of pathology, and some new Medical Schools began to create new museum collections, and older ones adapted themselves for teaching in the 21st century.
While I was doing post graduate studies in London in 1963 and 1964, I visited some of the London museums. This stimulated my interest in visiting other similar museums. In 1980 I was introduced to the European museums by Professor Werner Dutz, Professor of Pathology at the University of Richmond, Virginia, USA.
He was trained at the University of Vienna, and spent most of his professional life in Teheran, Persia. He had wide interests that included, Museums, Tropical Pathology and Medical History. He whetted my appetite for museums by taking me to visit the Narrenturm - The Museum of the Pathologic – Anatomical Institute in Vienna.
I would like to present what some old museums are doing to adapt to teaching in the 21st century, and what some new museums are doing.
1993 - Robin Cooke, Erika and Werner Dutz and Roma Cooke.
Breakfast in Innsbruck, where we were attending a meeting of the European Society of Pathology.
The Narrenturm Museum
The Narrenturm Museum
The Museum of the Pathologic – Anatomical Institute, Vienna.
2016 (News Bulletin in which this was reported)
The museum is a five storey, brick building in the grounds
of the old General Hospital.
It was erected in 1784 to accommodate violent psychiatric patients.
2016 - The Narrenturm had a central courtyard, and the building itself had individual cells opening from a corridor. This allowed each of the 139 cells to have access to the open air.
In 1796 it was converted to a Museum, and in 1974 it became a National Museum.
The former cells are now used to display the exhibits of the museum, as well as office space and work space for maintenance of the specimens.
2016 - The current Curator is Mr. Eduard Winter.
When I visited in October 2013 he had recently received a grant to undertake renovations, and these were under way.
In 2012 they had 26,000 visitors, but they are allowed to open only two days a week. Medical students are now coming to study the specimens.
Two of Carl Rokitansky’s first specimens.
A skeleton of a patient with Rickets.
Front and back views of a segment of small intestine in which there are multiple aneurysms on the mesenteric arteries. (In passing, note the absence of fat in the mesentery.)
The Rudolph Virchow Museum in Berlin
I visited Berlin from September 18 to 20, 2013. I was met by Prof. Manfred Dietel, The Director of Pathology at Charite Hospital, who kindly gave me permission to examine the specimens, to take photographs and to publish them. He introduced me to Miss Petra Denning, Assistant Curator of the Medical History Museum and asked her to assist me.
The Director of the Museum, Prof. Thomas Schnalke was in London attending a meeting of the Society of Medical Museums of Europe, of which he was the current President. Petra was a most gracious host. She went out of her way to help me to find out about things related to the Museum, and to assist with the photographs; in particular, interpreting the captions that were in German, and providing much background insight into the provenance of the individual items.
Entrance to the Virchow House in which there is the Museum as well as offices, diagnostic and research laboratories.
The museum exhibits are displayed on new, well-lit display stands. This one is a display of bone diseases.
If we were to choose the item that was Virchow’s main contribution to an understanding of disease, it would be his book
‘Die Cellularpathologie,’ 1858.
Images above show:
Virchow’s microscope (left).
It is about 20 cms. high (about the same height as the book stood on its end) It has no condenser, and the optics are very basic.
A first edition of ‘Die Cellularpathologie’ published in 1858 (middle).
A photograph of Rudolph Virchow (1821-1902) from the book (right).
The book is written in chapters that consist of lectures.
The main theme is enunciated in Lecture 1. ‘Previous Anatomists have viewed the outside of the body, and the gross appearance of the organs.
I have gone further, and demonstrated the microscopic structure of
plants with big cells, and humans with smaller ones.’ His main contribution to an understanding of disease processes was - ‘Cells produce other cells that form tissues, and tissues form organs.’
The diagram to illustrate this in German (left).
The second edition was published in Japanese as well as German (middle and right).
At that time, many Japanese pathologists were being trained in Germany.
Two old museums in London
The Hunterian Museum in the Royal College of Surgeons, London
2007 - The Hunterian Museum
Entrance with portraits of William Hunter (1718-1783) on the left and John Hunter (1728-1793) on the right.
The Hunter brothers were distinguished teachers of anatomy in the late 1700s.
At his death, John left a big collection of specimens which were purchased by the British Government in 1799.
The Government donated them to the Company of Surgeons, now the Royal College of Surgeons, for teaching surgeons. The College has continued its teaching role ever since.
Images to the left from 2007 show:
Two of John’s most famous specimens demonstrate the treatment of aneurysms of the popliteal artery, by ligation of the artery proximal to the aneurysm.
2012 - The ‘crystal room’ inside the entrance to the Hunterian Museum.
This is a special collection dedicated to visits from members of the public.
It features the historical specimens from John Hunter, including the acromegalic ‘Irish Giant’ Charles Byrne (1761-1783) who measured 7 feet 6 inches (2.3 metres).
A separate collection in the Hunterian Museum which is for the education of undergraduate and post graduate students. It is arranged in sections according to organ. This display is of lung anatomy and pathology. Normal specimens left and pathological specimens right.
Both of these museums were rejuvenated in 2012. This building was closed and demolished in 2016, to be replaced by a new, modern building. The specimens were carefully packed and stored before the demolition began.
Further renovations of the specimens are being undertaken while the new building is under construction, and new exhibits are being prepared. It is hoped that the new building will be opened in 2022.
The Gordon Museum in Guy’s Hospital, London
These photographs were taken during a visit in October 2015. In the previous few years quite a few of the central London pathology museums were closed, and specimens were transferred to the Gordon Museum. This allowed the Curator, Mr. William Edwards to increase the range of his exhibits. He also had the opportunity to have a major renovation of the building. The walls were painted, new lighting was installed and a new floor covering was laid. This created a very friendly atmosphere in the museum.
2014 - The Curator of the Gordon Museum welcoming visitors.
2014 - The museum has a ground floor with two tiers of walkways in which the pathology specimens are displayed.
The new lighting and new painting have created a very pleasant, friendly environment.
The ground floor contains the wax models made by the moulageur, Joseph Towne in the 1800s. On the far wall there are portraits of the three great nineteenth century physicians of Guy’s left to right - Addison, Hodgkin and Bright. The door leads to other similar rooms.
2014 - Gordon Museum ground floor with wax models, portraits of Addison, Hodgkin and Bright. Some students are studying.
A recent project
A recent, and ongoing project is that Curator has engaged pathologists to make video descriptions of all the specimens which are loaded onto ipads that students can borrow.
2014 - Curator, Bill Edwards demonstrating one of the ipads. Closeup on the right shows a specimen of submucosal oedema in the colon. This may occur in a number of conditions, including chronic inflammatory bowel disease.
The museum can be hired by special interest groups for functions .
I have chosen three museums that were established after 1970 to demonstrate what the Professors of Pathology have done to teach pathology using the technology available in the early part of the 21st century.
One - Museum in the Australian National University, Canberra, Australia
Museum in the Australian National University, Canberra, Australia
History of the Peter Herdson Museum at the ANU, Canberra.
The first pathology specimens were collected in the 1950s, by the first pathologist appointed to the Canberra Hospital. Peter Herdson (after whom the Museum was named) was appointed Director of Pathology in 1991. He appointed a scientist to be Curator of the specimens already collected, and to mount new specimens. The ANU Medical School was established in 2002, and Jane Dahlstrom was appointed Professor. With the help of the Hospital pathologists, Jane set about increasing the number of specimens in the museum.
In a new initiative for Australia, she made two collections – one to be mounted in perspex jars, and the other to be a collection of wet specimens kept in plastic bags, so that she could take them with her when she drove to other places where the University had established rural clinical centres. There were 5 such centres within 300 kms of Canberra. Jane drove to these to give regular lectures, in which she was joined by the surgeon at the hospital. In 2012 she obtained a grant that allowed her to establish small, permanent displays in the rural centres. In 2021 there are 800 potted specimens, and 1,000 wet specimens.
Focus of the Museum
From its inception the museum was used for teaching undergraduate and post graduate medical students, Nursing and other Allied Health Professional students.
In the past 10 years it has been open by appointment to members of the public – high school students and other groups.
Other teaching programmes are being added as the opportunity, and the technology become available.
One of these was the photographing of the specimens and preparing them for being made available for on line learning by students.
In 2021 they added an online radiology programme with images to match the potted specimens.
Professor Jane Dahlstrom took me for a tour of her museum in 2013.
2013 - Professor Jane Dahlstrom demonstrating some of the specimens in her museum.
Mrs. Adrienne Heckenhan, the Curator in the preparation room with the equipment and perspex storage containers for wet specimens, and some recently potted specimens.
Wet specimens in airtight boxes ready to be taken to other centres for teaching sessions. Professor Dahlstrom has received National and International awards for Teaching.
James Cook University, Townsville, Queensland, Australia
The James Cook University (JCU) was established in 1970. A School of Medicine and Dentistry was added in 2000. A Pathology Museum was begun with some specimens that the hospital pathologist had accumulated, and some that were donated by the University of Newcastle School of Medicine and Public Health, that had opened in 1975.
The Department of Anatomy had a facility for students to perform dissections on bodies donated for this purpose. They appointed a museum curator to use pathological organs taken from the bodies for mounting as pathology specimens. A number of new Medical Schools were opened in Australia in this period.
A Head of Department was appointed, but no other teaching staff. Associate Professor Shashidar was appointed to head the Pathology Department in 2005. As well as the campus in Townsville, the University opened a second campus in Cairns, a city that is approximately 300 kms north of Townsville. To help rectify the lack of staff, Shashi introduced a number of innovative teaching activities -
1. A video conferencing programme, so that his lectures could be viewed in real time by students in Cairns.
2. Soon after this, he purchased a programme whereby all the students were given a small ‘clicker.’ At the end of his lectures he would ask multiple choice questions which the students had a set number of minutes to answer. The students chose the most appropriate answer by clicking its number. Then a graph would appear on the screen so that each student could see where he/she fell on the graph.
Each clicker was tagged, so that Shashi could email students who performed badly, and ask whether they would like him to give them some extra tutoring.
He was able to demonstrate a statistical improvement in the pass rate of the class after he introduced this programme.
3. Another of his initiatives was to develop a Digital Pathology Laboratory and Museum, that contained gross and microscopic images that covered all the organs of the body.
These programmes are freely available on the web.
4. He was able to invite some of his friends to be external lecturers and examiners. I was privileged to be one of those.
He received a Commendation from the University for these teaching initiatives.
2013 - Professor Robin Cooke delivering a lecture at James Cook University, Townsville (black arrow). There is a laptop computer on the podium, from which the lecturer delivers the lecture.
Every two students have a screen on their bench so that they can view the same image as the lecturer. In this case it is a microscopic section of a normal pituitary gland.
Museum of Modern Medical Education
The Kawasaki Medical School, Kurashiki city, Japan.
The Kawasaki Medical School is a private medical school that opened in 1970, with 100 students in each year of a 6 year course. In 2020 there were 126 students in each year.
Note: This report was published in News Bulletin 2001-03 and subsequently updated in October 2021.
In addition, Kawasaki Education Institution now has 6,000 students each year from the following institutions -Kawasaki University of Medical Welfare, Kawasaki Medical College, Kawasaki Junior College of Rehabilitation, High School attached to Kawasaki Medical School and Kawasaki Childcare Center.
All of these students come to the Medical Museum to study.
In 1970, the traditional medical course in Japan was based on lectures that were research orientated. The Kawasaki school used an integrated, patient orientated
method of teaching. To help to achieve this they used audio-visual materials. However, these were not popular with students, so the format of teaching had to be revised.
In 1980, to mark the 10th year since the foundation of the Medical School, a new building was constructed as an educational museum designed to be a better way of
presenting interactive learning opportunities for both undergraduate and post graduate students. An addition to this was the opportunity to help to provide facilities for ongoing education of physicians.
Professor Toshiaki Manabe was Professor of Pathology during this time and he had a considerable input into the design of the course, and of the new building.
( Toshiaki is now Professor at Kyoto University).
A 5 storey, purpose built building was constructed a short distance away from the Medical School and the teaching hospital.
All the buildings are connected by underground passages so that access is easy under all weather conditions.
Initially 13 staff were appointed, but this number quickly rose to 16. They prepared interactive exhibits that used models, as well as real anatomical and pathological specimens. In 2000, 20 years after its establishment, there were 2 medical and 10 technical staff. In 2021, the staff number has not changed.
Anatomical and pathological specimens are prepared using a number of different techniques –Perspex jars, plastination, corrosion.
The emphasis is on modern medicine rather than on historical items. Progressively, more and more material is being presented as computer based learning exercises.
The first floor is equipped as a Health Education Museum which is open to the public from 9am to 5pm every day except Sundays and holidays. This attracts over 6,000 external visitors annually. By 2020 there were 8,000 visitors, including about 100 groups. These include high school students, the general public, ambulatory patients and their relatives.
The second floor has now also been converted into exhibition space for Health Education. The contents have been progressively updated. (In 2020-2021 the space is closed to the public because of COVID-19.) Short periods of on the job training for elementary school, junior high school and high school students are being provided. From the summer of 2009, elementary school students, junior high school students and their protectors, have been invited to one day courses of study.
These courses are repeated on two consecutive days with100 children attending each day. In 2019 the Museum staff received a commendation from the Japanese government for their performance.
2011 - Museum of Modern Medical Education
The Kawasaki Medical School
Professor Takuya Moriya and his Museum staff in front of a large model of a full term foetus that welcomes visitors at the entrance to the Museum.
View of the Museum interior with a station for private study.
I would like to thank the Curators of the various museums who kindly provided me with background information about the specimens and gave me permission to examine and photograph the specimens for the purpose of composing an article for publication. My wife and daughter have kindly acted as proof readers.